Infectious Disease Prevention

Johns Hopkins University has been working collaboratively with Native American tribes to prevent infectious diseases of concern to Native American communities for almost 30 years. In the early 1980s, Mathuram Santosham, MD, MPH, and Raymond Reid, MD, MPH, worked with the White Mountain Apache Tribe to implement a program of Oral Rehydration Therapy (ORT) to reduce the disproportionate burden of hospitalization and death due to diarrhea and dehydration in White Mountain Apache children. Although ORT was widely used in developing world settings, this was the first time it was used as a treatment and prevention tool in the United States. ORT is now recommended for the treatment of diarrhea with dehydration by the American Academy of Pediatrics. ORT has had a profound impact for Native Americans and other populations around the world. The rate of diarrheal deaths for Native American children has dropped almost to zero, and the White Mountain Apache Tribe has been recognized by the Global Health Council for its contribution to the control of death due to diarrhea worldwide.

Following the tremendous success of the ORT work, Dr. Santosham and Dr. Reid turned their attention to the devastating burden of illness and deaths among Navajo and Apache children from Haemophilus influenzae type b (Hib) disease.  A hallmark study undertaken by Dr. Santosham and Dr. Reid in the late 1980s and early 1990s proved the efficacy of a new vaccine to prevent serious illness due to Hib.  Hib vaccine is now a part of the routine childhood vaccine schedule in the U.S. and many countries around the world.

Prior to the development of this vaccine, meningitis, pneumonia, and bacteremia due to Hib were much more common among Navajo and Apache children than other children in the United States. Now these diseases have been virtually eliminated in Native American communities.

In 1991, following the Hib vaccine trial, Dr. Santosham founded the Johns Hopkins Center for American Indian Health. The Center was created to provide a framework within which health issues of importance to American Indians could be addressed more broadly. The Center continues to work in the area of infectious diseases in addition to other areas of need. The Center has grown to include 4 additional I.D. faculty members who work to advance the mission of the Center through research and training. The Center conducted a large study of a vaccine to prevent Streptococcus pneumoniae (pneumococcus) between 1997-2000. Like Hib, pneumococcus disproportionately affected Navajo and Apache children. This new vaccine, now licensed as Prevnar, has led to substantial decreases in pneumococcal meningitis and other serious pneumococcal infections for Native American children. The Center continues to monitor the incidence of disease due to Haemophilus influenzae and pneumococcus and to assess the impact of the Hib and pneumococcal vaccines.

The Center has continued to work with the Navajo and Apache communities to monitor and control diarrheal disease and serious bacterial infections. In 2002, the Center began studying a new vaccine to prevent disease due to rotavirus, which remains the most common cause of serious childhood diarrhea in the United States.*  The Center has begun to work on other priority diseases affecting Native American children, including bronchiolitis due to respiratory syncitial virus, respiratory illness from influenza virus, and infection with Helicobacter pylori, which can cause gastric ulcer and gastric cancer later in life.

*This trial was completed in 2004 and the vaccine was found to be  highly effective.  It has recently been licensed and recommended for routine use.

The Center has been increasing efforts to address infectious diseases that particularly affect Native American adults. For example, studies carried out by the Center have shown that pneumococcal infection is much more common among Navajo and White Mountain Apache adults than in the general U.S. population. These studies have also shown that the currently available pneumococcal polysaccaride vaccine does not provide adequate protection for Navajo adults, particularly those with chronic illnesses. The Center is working to further define the burden of pneumococcal disease in Navajo and Apache adults and to explore new vaccines that might offer better protection against pneumococcal disease, particularly pneumonia. The Center has also been involved in efforts to prevent hepatitis A among Native American adults.

The infectious disease research activities of the Center for American Indian Health provide an excellent opportunity to train Native Americans in public health and clinical research.  Over the past decade, dozens of Navajo and Apache tribal members have been trained in survey methods, data management, phlebotomy, vaccine trials and public health field research while working with the Center. Several of these tribal members have gone on to further study in public health and nursing. Our goal is to increase the training opportunities available through these infectious disease research activities in order to fulfill the mission of the Center: to work in partnership with American Indian tribes to raise the health status and self-sufficiency of American Indian people to the highest possible level.

Current study sites include:  Arizona - Chinle, Ft. Defiance, Tuba City, Whiteriver and Winslow; New Mexico - Crownpoint, Gallup and Shiprock.

Current I.D. faculty: Mathuram Santosham, Raymond Reid, Kate O'Brien, Aruna Chandran, Eugene Millar and Mindy Perilla.

Current listing of CAIH publications in peer-reviewed journals.

For more information on Infectious Disease Projects at the Center for American Indian Health, please contact the Center in Baltimore at  (410)  955-6931 or Dr. Raymond Reid in Shiprock, NM at (505) 368-4030 or Whiteriver, AZ at (928)  338-5215.